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0312-075 (PLBG)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and 'my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: b �, ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ,^ ( ) I am exempt under Section B&P.C. for this, reason /.• /Date Signature of Owner :�Ci'•fr�.�Z .,r5 �� 6 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier.:: Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of t'he Labor Code, I shall forthwith comply withithose provisions. s� /Date: Applicant -/4,2f / X C i% ., 4V Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this,•City to enter upon the above-mentioned property,,for inspection purposes. Signature (Owner/Agent) Date N' BUILDING PERMIT PERMIT# DATE VALUATION LOT T�ACT w JOB SITE APN ADDRESS 52_5-10 ��ilk: t IJY 033RFCYO OWNER CONTRACTOR/DESIGNER/EN (NEER RKFUG-10 LOPEZ JVi)1'.E.,R B1:JYL.I)M 32-3 I 0 AVENJDA 013YM 30X U% QUWTA CA, 92233 r' USE OF PERMIT SEPTIC ABANDON A 3-VtM R CONNECTION. VALUATION 400.00 .L;i EST'd ATM.) COS:!' OF C ODAR1911RD,M- OH 9dbPJM PKRL J' FEE M/.K ARY PlsilMBING FEE SEWER 101.000-439.000 D DEC 0 8 2003 CITY OF LA QUINTA FINANCE DEPT. IUB -TOTAL CONS') R C—MON ANP PLAN (7 ?,C`'iC $30.00 LESS PRE -PAW YN $0100 "1*07 AL PTU00 " FEXS TilUF:,N0W :00.00 RECEIPT DATE _ % BY DAT FINALED INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond B Am Approval to Cover Equipment Location • Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances C/G Final Final Utility Notice (Gas) -- ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exteri;r Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: sh Water Service f`.L.. E(.:�„ eck t Eley ler . r Cashier CYWD 438(11/89) drawing of record. These deviations from the drawings of record are beyond the control .of CVWD; therefore, the district will not be responsible for any charges COACHELLA VALLEY WATER DISTRICT j �l CASH RECEIPT DETAIL 9+e aY00®'� g, �y �Cg1 '4e9 3 Received From: 1� 1 ! - l._ i ...,,� _� —7L ff tJ _ i i Address: �•.-r-'1 �3.. 1. U0 L s.�_i Lid. Date: l\�l:'ij� Account No. i .: .� /. �? ! .Lot() Tract _a ..�r•'S ! �-�C �4' � �t� +1_(• ; (%, _l�s..i�. {� Service Address +; - ._ l._ 4 11'; � .�.�.�., r . ...:r G.A. Code ❑ Meter(s) $ '1 -=i ❑ Service(s) ❑ Backflow(s) $ ❑ House Laterals) . ❑ DetectorCheck(s) ❑. Meter Surcharge 11 ' Sanitatlon Capacity Charge ❑ W S B:F,C. ' O Temporary C.onstruction•Meter i ,.,.•� ❑ _ Turn on Charge V ❑ Uncollected Account -Name ❑ Inspection Fee - Tract Fee ❑ Plan Che ck,Fees Water ./S dviier.- Tract - ❑_ Bond Payment 'A.D. - Bond Assmt. O Customer Deposit 5 ❑Other , Z "yr NOTAL $ Remarks: i ` 0Copy to: _ sh Water Service f`.L.. E(.:�„ eck t Eley ler . r Cashier CYWD 438(11/89) drawing of record. These deviations from the drawings of record are beyond the control .of CVWD; therefore, the district will not be responsible for any charges OWNER / BUILDER � � INFORMATION Dear Property Owner: An application for a building permit -has been submitted, in your name'listing yourself as the builder of the property improvements specified: r... yFor your protection you should be aware that as "Owner/Builder" you.are'the responsible party of record on such a permit. Building permits are not iequired to be signed by property owner's unless they are personally performing their own work. If your work is being perforri ed; by.'someone other than yourself :'you may pro ect yourself from possible liability if that person appliesfor the.proper-permir,iri his. or her name. Contractors are 'required bylaw to; be licensed acid bonded by the State of Cal ifornia'and to have a business license from the City of County. They are;also required by law to put their license''number on all permits for which they apply. If you plan to do your own,work, with the exception:of various trades that you plan to subcontract, you.should be aware of the following information;for.your benef`t and.protection: If you employ or otherwise engage any persons other than,:your immediate farnily, and the work (including materials and other- costs) is $200:00 or' more ,for the entire .project,: and such persons are not licensed as contractors or subcontractors, then you may be ain employer. If you are an employer, you,must register with the State and'Federal`Government as an employer and you are subject to several obligations 'including State..and Federal income tax withholding, -federal social security taxes, worker's compensation insurance; disability insuiance costs and:unemployment compensation contributions. There may be financial :risks' for you if you do not carry our these`obligations, and -these risks are especially serious with respect to worker's compensation insurance. For more specific information:about your _obligations under,Fedeial:Law,_contact the Internal Revenue Service (and, if you wish, the U.S. Small $ustness Adminstrauon)':' For more specific infoimaiion about`your obligations under State Law, contact the Department of - enef t Payments and the," Division of Industrial Accidents: If the structure is intended for sale, property owners -who are:not license&contractors are allowed to perform their work personally or through their own employees, Without a licensed conttractor, orsubcontractor, only under limited conditions. A frequent practice of unlicensed persons professing,,to be:contractors is to:secure an "Owner/Builder" building permit, erroneously implying that ihe,property owner is providing his -or her: own labor. and, material personally. Building permits are not required to be signed by. property owners unless- they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building -permit will,riotbe"issued until the v'erification.is`returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (AO) 777- 11 X / ER'S SIGWAT_ UA& /DATE' �- �-I o AV IlV DA- 03_1 -V_ -40/t/ PROPERTY ADDRESS 0-3 PERMIT NUMBER(s) e !�- ❑ HEMET (909) 658.8541 RO O ❑ LAKE ELSINORE (909) 674-2312 ❑ FALLBROOK & BONSALL (760) 728-7497 ❑ WEST RANCHO BERNARDO & WORK ORDER NO. / -r ❑ BANNING (909) 922-9491 - RDOTERtt ❑ BEAUMONT (909) 845.3338 ❑ RANCHO/TEMECULA (909) 699-0555 ❑ REDLANDS/YUCAIPA (909) 797-8697 ❑ OCEANSIDE, CARLSBAD (760) 722-3155 ❑ VISTA &-r If c TIES AREA (760) 726.6260 WEST RANCHO PENASOUITOS (858) 4842138 ❑ LAKE SAN MARCOS & LA COSTA (760) 726-6720 261462 t ❑ PERRIS (909) 657-9852 ❑ PALM SPRINGS/DHS (760) 322.2622 ❑ ENCINITAS & CARDIFF (760) 753-2674 ❑ RANCHO SANTA FE & OUVEHAIN (858) 756.3396 ` ❑ SUN CITY (909) 679-8919 ❑ INDIO/PALM DESERT (760) 346.1736 ❑ DEL MAR & SOLANA BEACH (858) 481-1633 DAT S " G Plumbers Division of RotoCo.. Inc. License Number 422155 • Federal ID Number. 33-0475032 I. E ........................................ JOB# ................................. :......................... o ,796 N. STATE STREET • HEMET, CA 92543 Toll Free: (800) 491-7686 Fax: (909) 65279515 •# 1-800 GET ROTO (438-7686) '(FIXTURE MAIN LINE: TECH #1 .........f�l•...( ....'....... TECH #2 .............................................. FT❑ BATH SINK --------0 FLOOR DRAIN -----0 JOB NAME PURCHASE ORDER # CLEANED: _ TOILET - - - - - - - - - - -0 KITCHEN SINK - - - - -0 FLOOR SINK - - - - - - -0 G�C)Lve `Z BATHTUB ---------0 ' LAUNDRY --------- JOB ADDRESS 1 ) CITY 1STATE ZIP t tr4 DYES GUARANTEE ❑ No 8 A.M. - 5 P.M. MON. THRU FRI. f INITIAL FOLLOWING: -I SHOWER ---------0 URINAL -----------0 LACCESSED VIA CAUSE OF STOPPAGE IN ❑ CLEAN OUT ❑ ROOTS ❑ GREASE ❑OTHER ❑UNKNOWN ,TIME IN ESTIMATE: My estimate for performing this work is: $ WORK ORDER AUTHORIZATION / WAVIER: I authorize Roto -Rooter to perform the described services and I agree to pay the amounts Indicated. I understand that Roto -Rooter is not responsible for broken; settled, rusted, deteriorated, or lead pipes, fixtures, or clean outs and any damage resulting from cleaning or repairing such lines. I have asked Roto -Rooter to provide services, Under Section 1689.13 of the California Civil Code, In order to Induce Roto -Rooter to provide these services; 1) Initiated negotiation and contract; 2) executed this contract in connection with the making of emergency or Immediate necessary repairs or services necessary !p1'1!6e Immediate protection of persons or personal property detailed on this Invoice; and 3) 1 expressly acknowledge and waive the right to cancel this contract within three or seven business days, whichever applies. /)", O � 11//' Ci ?_ 6- h:. , .q' - A. The serviceman discussed Roto -Rooter products with me. B. s V I have been advised additional lines cleaned at this time are half prices. C i have been advised that running my main line from a 3" roof vent is Improper access and can only be given•a 10 day guarantee, a 2- main line has a "z to guarantee. In order to get a 120 day guarantee a cleanout must be installed. id work which has been done to my complete satisfaction. AREA DRAIN -------0 OTHER O CCI - EXRDATE APPROV. # I hereby authorize Rotoco, Inc. to charge my Credit Card for the above charges. I understand that by signing below I am agreeing to all charges incurred on this invoice and that the work was completed to my satisfaction. Cardholder Signature X " CLEAN UP ❑EXCELLENT ❑SATISFACTORY C1 POOR E' CASH El BILL CK #% O El CREDIT CARD/TYPE SEE REVERSE FOR TERMS °& `CONDITIONS .-CUSTOMER COPY �f !, CONDITIONS AND EXCLUSIONS Roto -Rooter Service & Plumbing Co. guarantees the services performed as set forth in this invoice to be free from defect in materials or workmanship for the applicable time period stated above. If within the Guarantee Period a drain stoppage or other defect in the repair of plumbing fixtures or plumbing parts installed by Roto -Rooter Service & Plumbing Co. occurs, Roto -Rooter Service & Plumbing Co. will clear the drain stoppage or, repair or replace (at Roto -Rooter Service & Plumbing Co.'s option) the plumbing fixture or plumbing part previously installed at no cost to customer, subject to the following exclusions and limitations: 1. This Guarantee applies only to the specific sewer lines cleaned, or plumbing fixtures or plumbing parts supplied and installed by Roto -Rooter Service & Plumbing Co. 2. Roto -Rooter Service & Plumbing Co. must receive notice of the defect within the Guarantee Period. 3. This Guarantee does not apply to: a. Multi Unit Dwellings sewer and drain lines, plumbing fixtures or plumbing parts. b. Materials furnished or work performed by other than Roto -Rooter Service & Plumbing Co. c. Drains, sewer lines, plumbing fixtures and plumbing parts which have been misused, abused, damaged or modified by others; d. Drain or sewer line stoppages caused by foreign objects, including but not limited to sanitary articles, paper towels, toys, etc.; or e. Sewer lines which are settled, broken, offset deteriorated, damaged or improperly or illegally installed. f. Drains, sewer lines, plumbing .fixtures on septic systems. g. Commercial accounts. 4. The Guarantee Period commences on the date or, original service and shall not be extended by subsequent services or repairs made pursuant to the terms of the Guarantee. The Guarantee hereunder exiends to the customer invoiced for the services and is not transferable. 5. Roto -Rooter Service & Plumbing Co.'s liability hereunder shall be limited to recleaning of drain or sewer stoppage (Max. two repeat visits) or the repair or replacement of defective plumbing fixtures or plumbing parts: Roto -Rooter Service & Plumbing Co. shall not be liable for (1) Incidental or consequential damages; (2) Water or other damage; (3) Loss of use; or (4) Loss of anticipated benefits or profits, any of which result from the furnishing of services or products, or from the breach of the Guarantee, even if Roto -Rooter Service & Plumbing Co. knew of the likelihood of such damages. 6. Any implied warranty of merchantability, or fitness for a: particular purpose of use, shall be limited to the duration of the foregoing written . guarantee. The foregoing written guarantee is the customer's sole and exclusive remedy and in lieu of all other guaranties and warranties, express or implied, written or oral. This guarantee may only be modified in writing, signed by an officer of Roto -Rooter Service & Plumbing Co. 7. This guarantee does not apply in the event customer breaches any of the Terms and Conditions of service, including but not limited to timely - payment of all charges. 8. Collection. Owner agrees to pay all collection fees and charges including but not limited to all legal and attorney fees that result should Owner default in payment of this contract. Overdue accounts are subject to interest charged at the rate of 18% per annum. 9. Legal Fees: In the event litigation arises out of this contract, prevailing party(ies) are entitled to all legal, arbitration, and attorney fees. The court shalt not be bound to award fees based on any set, court fee schedule but shall if it so chooses, award the true amount of allcosts, expenses and attorney fees paid or incurred. TERMS: NET 10 DAYS. A FINANCE CHARGE will be computed on the unpaid balance by a single period rate of 1-112% per, month, which is an ANNUAL PERCENTAGE RATE OF 18 %. "State law requires any one who contracts to do construction work to be licensed by the Contractors State License Board in the license category in which the contractor is going to be working - if the total price of the job is $300 or more (including labor and materials). Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license. The Contractors State License Board may be unable to assist you with a complaint. Your only remedy against an unlicensed contractor may be in civil court, and you may be liable for damages. arising out of any injuries to the contractor or his or her employees. You may contract the Contractors State License Board to find out if this contractor has a valid license. The board has complete information on the history of licensed contractors including any possible suspensions, revocations, judgements and citations. The board has offices throughout California. Please check the government pages of the white pages for the office nearest you or call (800) 321-CSLB for more information."